Benign paroxysmal positional vertigo
BPPV is the acronym for “benign paroxysmal positional vertigo”, and just like the title says, it is both benign, and positional – the “benign” part indicating that there is nothing too sinister to worry about, and the “positional” part referring to the idea that symptoms can be triggered by moving or changing head position.
It is classified as a “peripheral” disorder, meaning that it is not a problem of the brain, rather a problem of the inner ear. It is actually the most common disorder to cause vertigo, accounting for an estimated 20-30% of cases. Fortunately, it is also the most treatable cause of vertigo, with the canal-repositioning manoeuvre being highly effective.
After the age of 60 years old, the prevalence of BPPV is approximately 7x more likely than that of an 18-39 year-old, and females are 2-3 x more likely to get the problem than men.
It is proposed that little calcium debris called otoconia, are dislodged from their position at the utricle (see diagram) and make their way to the semi-circular canals of the vestibular system. It is most likely that the debris will find its way to the posterior canal (90% chance), due to the path being most accessible, however, they can also be dislodged and enter into the horizontal and anterior canals.
Once the otoconia are in the semi-circular canals, they are able to activate delicate hair cells which are the motion-sensors of the inner-ear, creating a sense of motion which is illusionary, or not real. This is often described as a sense of “spinning”, or vertigo.
The typical duration of vertigo for BPPV is less than 1 minute, however, in some cases it can go on for much longer. The treatment will vary depending on how long the symptoms persist, however, no more than 1-3 treatments are generally required to resolve symptoms.
Treatment techniques for BPPV involve manoeuvrers which aim to reposition the debris from the canal back to the area from which it was dislodged. Your clinician can do this for you after clearly defining which semi-circular canal is affected. The Epley manuevre is the most well-recognized and effective treatment for BPPV (in the posterior canal).
